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03020027 CTTY OF CUPERTINO B UILDING DIVISION PERMIT C0NTRACTq 4INVORM, QNN {b45'ttizx.x , BUILDING ADDRESS: PERMIT"0 3 02 002 7 ER'S NAME: PERMIT Saffn 6/2 0 0 3 G LEE/QUIZNO' S SUBS NE: SANITARY NO. CONTROL NO. ARCHITECHENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 3o Z' LICENSED CONTRACTOR'S DECLARATION I herchy M.that l am it¢nsed ndr Fannie.ON or Chapter 9(commencing Job Description < with Sectthn7 )of DiWman3of me 9uv sand Profesdans Cade,. mylicenab in r.n ma a ser. ���s TENANT IMPROVEMENT P�NAL.E© j N 3 Licence las te.N Date Cant r CONTRACTOR: RTJN 9rg n ARCHITECTS 0 ATION �i W I d my plans%hall W used u public record JUL t O 1 7003 OyU a/�!L [UUJ C Li used si...I OWNER-BUILDER exempt f DECLARATION Kw'' p� It by a0irm then 1 em exempt Tam the Contractors Licence Lew for the W'�D'IY� O o toll. a.(Section 7I31.5,Business and Pmfessionr Cade:Any city or county S O� which requires a Permit to construct.alter,improve,demolish,.r repair any structure prior in its issuance.also squires the applicant for each permit to rile signed sutement < WlheislicensedputeaantinMcprovisionsoftheConoactor'sLlcanseLaw(Chapter9 Sq.Ft.Floor Area Valuation sJ�$ (commencing with Section 7000)of Division 3 of the Business and Profusions Cade)or 100000 that he u exempt therefrom and Ne basis for the alleged exemption.My violation Of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mos than Ove hundred dollen($300). ❑1,as owner or the property,or my Employees with wages as their sok Compensation. 31621029 . 00 will do the work.and the structure is not intended or offered for sale(Six,9044,Buimv j��,py dins actions and Professions Cod:The Carro rs License Law does not apply m an owner of 101 - FOUNDAT lU p property who builds or improves thereon.and who doessuch workhimself or through his Own employees,provided that such improvements ane not intended oraBcred formic.If. 102 — PIERS however.Ne building or improvement is Cold within one year of completion,Ne owner. Wilder will have ft burden of preving that he did mut Wild or improve for purpose of 103 — UFER sele.)' 104 - REBAR ❑I,as owner of the property,am exclusively contracting with licensed convectors to 105 - ANCHOR BOLTS construct the project(Sec.7014,Business and Professions Code:)The Contr c ts't.4 cense Law does not pply in in owner ofproperty who build.or improaes Mariann.and, 106 — SEWER & WATER Lwho icense Law. tach projects wiNaan.aemr(q Restated pursuant anti.Convanora 202 - UNDERFLOOR PLUMBING O l am exempt under See ,B k P C far this reason 203 - UNDERFLOOR MECHANICAL ° Data 204 - UNDERFLOOR. FRAME l WORKER'SCOMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION \�I I hereby sham under penalty of perjury,am of the following declaulionx have and will mainwm a Certificau ofCorucm m mlf-insure rorwod.rsCompcm 301 — ROUGH PLUMBING asprovided for by Section 37M of the 1sWr Code,for EYES par mmance of the 302 — TUB & OR SHOWER for which this permit is issued. 303 — ROUGH MECHANICAL have end will maintain Worker's Compensation Insurance,as required by Section3O4 — ROUGH ELECTRICAL of the labor Cad°,for ti.performance or the work for which this permit u Issued.Warkr'.Co. y+� Insunnca camerand Policy numbe 305 — FRAME EOF 306 - HOLDOWNS CERTIFICATE PENSA ONTNS INSURANCE RKEas 307 - INSULATION rrhlaactionneed not he completed irutapermit isforam handraddoltars(SIM) 308 - SHEETROCK mrieSt) 309 - EXTERIOR LATH 1 certify that in the performance of the work For which this Permit u issoed,1 shall not 3 10 — INTERIOR LATH employ any parson In any manner m as.become abject in the WorkcunsN 'Compeon LawsAppliOfCalifornia.Mae nt 311 - SCRATCH COAT NOTICE NOTICE TO APPLICANT:IL after making this Certificate of Labor on you should 313 - ROOF NAIL ,JObecome comp y the Worker's Compcor this pavilions or Se tabu Code you mull forthwith comply with ash pmdsinas or this perm slim be deemed revoked. . 501 — FINAL ELECTRICAL ENERGY Z"' CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY (..� Thereby air..met then its cmutaNan lendi.,.,.cy l'.r the perf.manwe of 503 - FINAL MECHANICAL ENERGY x> mework'sName hm,Permit hln drsec.3om.cm.ca 504 - FINAL BUILDING ENERGY QLeader's Name Jz LeadersAenm.• 505 - FINAL ELECTRICAL U O I ccriry that 1 have mail this application and stat,that the above informatiun is 506 - GAS TEST coscct.1 agree to comply with all city and county ordinances and sues laws rthling to �U Euilda and hereby euthodm repssemNvas of this city to enter upon time FINAL PLUMBI G .Wverty far Inspection purposes 08 FIN L _ via indemnify and keep bumless d.City ofCupertinoagainst y liabiMU"dexpcoaswhichmeyinanywayaarueagaiast rtiO Clty 5j 1in cogranting of this PermitAPPRSTANDS AND WILL COMPLY WITH ALL NO -P INT Issued by:51 NG DatSOUIONS. _ Re-roofs S' or RcanUCanuactora HAZARDOUS MATERIALS DISCLO RE Type of Roof applicant or future building Occupant sarc or handle hammous material u derincd by the Cupertino Muni iPat Code.Chapter 9.12.ad the Health and Safety Seetion 25532001 All roofs shall be inspected prior to any roofing material being installed, ❑Yes Nu Will the applicant or future Wilding occupant use aqulperent or devices which 'If a roof IS installed without firs[obtaining an inspection,I agree to remove mot hazardous air contaminants as derincd by the Bay Area Air Quality Maagemcnt all new materials for inspection. District? C)Yea No Ihavc hvardoes m.crialsrtquirtments under Cbpter6.95 of the Calder. nice Healthh Code.ScW=25305.25533uu125534.1unhruv wifine building dens not cu y N a¢mm,mat it u my responsibility.notify the gaup t of dm requiremc hie USE be,met Our ea issuance oft Certifies.or acup ' Signature of Applicant Date Owner dr m yedagentAll roof coverings to be Class"B"or better